Narrative medicine in surgery: necessity or hindrance?
Authors: Jianyu Liao, Zhoupeng Wu
Journal: International Journal of Surgery (2023)

To the Editor: In the process of innovation of modern surgical medicine technology, evidence-based medicine-based evidentialism is in the leading position, while the concept of surgical technology-based technologism is increasingly rampant, making surgical medicine pale, cold, and mechanical, resulting in the gradual separation of medicine and humanity. The biopsychosocial medical model emphasizes the integrity of human beings and calls for the return of medical humanities. Narrative medicine originated from the literary narration, is a blend of medicine and literature. In 2001, Rita Charon1, who was the initiator of narrative medicine, first proposed the concept of narrative medicine and defined it as narrative medicine is a medical practice that uses a doctor with the narrative ability to recognize, explain, be touched, and take action to achieve empathy and reflection. Narrative medicine is a humanities-based discipline that posits that attention to the patient narrative and the collaborative formation of a narrative between the patient and provider is essential for the provision of health care. Surgeons need to be very careful and think about their own medical process in diagnosis and treatment activities. In clinical work, surgeons may attach great importance to surgical techniques and pay insufficient attention to the psychological changes of patients. Pain or stress after surgery may cause mood swings in patients, which may accompany the whole diagnosis and treatment process2. Surgeons need to pay more attention to the psychological changes of patients so as to increase the treatment effect of patients and increase the process of constructing the doctor–patient value community. Surgeons can improve their narrative ability through continuous training and improvement of humanistic care in diagnosis and treatment activities. Clinical decision-making is a choice made by clinicians based on existing medical evidence and clinical experience in diagnosis and treatment activities. At present, the majority of surgical clinical decisions are based on 'paternalism' and informed decision-making models. As the beneficiaries and risk bearers of medical decisions, patients lack professional medical knowledge. Therefore, in the medical decision-making process, doctors take the decision-making as the leading role, ignoring the participation of patients and their families, damaging patients' right to know and choice of medical treatment, which violates the concept of medical sharing decision-making. The current medical environment also urges surgeons to rely on evidence in decision-making, avoid potential medical hazards, and rely on evidence without considering the patient's values, cultural and religious background, family background, and other 'whole person' conditions, which will produce a huge difference between the treatment effect and the patient's expectations, and affect the effectiveness of decision-making3. Surgeons generally only consider the physical and biochemical indicators of the body when choosing surgery or surgical methods, often ignoring the psychological and social needs of individuals. Narration can enable surgeons to understand the implicit psychological and social information of patients, clarify the real needs of patients, and develop personalized surgical plans. It also allows patients to feel the doctor's respect for the patient's individual life, reconstruct the patient's cognition of disease and surgery, establish a positive attitude, and encourage patients to actively cooperate with the doctor's treatment in the physical, mental, and spiritual levels, so as to finally achieve the warmth of treatment. Narrative medicine, full of humanistic color, with its unique humanity and sensibility, can build bridges between surgeons and patients, technology and humanity, as well as medicine and literature, and promote the return of medical humanities4,5. Shared decision-making can best be understood as a continuum from strictly autonomous, patient-driven decision-making to value-neutral, physician-driven decision-making. When a difficult medical or surgical decision needs to be made, at their discretion, patients are encouraged to include friends, family, and other healthcare providers in examining how the outcomes of a particular medical or surgical decision align with the patient's culture, values, and preferences. Such an inclusive approach can result in greater patient empowerment, engagement, and satisfaction. Narration can enable patients to understand the complexity of surgical diseases and the uncertainty of surgical operations, as well as enable surgeons to think about the differences in the individual characteristics of disease and pain and the differences in the individualized effects of treatment and further reflect on the effectiveness of clinical decision-making, so as to improve the ability of shared decision-making. Narrative medicine focuses on the return of medical humanities to clinical practice, which can be used as a breakthrough in the construction of surgical humanities. Surgeons can strengthen their own narrative ability, strengthen the practice of narrative skills, strengthen the popularization of narrative medicine education, and also promote the development and prosperity of narrative medicine. Ethical approval Not applicable. Sources of funding There was no funding for our paper or any financial support. Author contribution J.L.: wrote the manuscript and collected data; Z.W.: revised the manuscript. Conflicts of interest disclosure There were no conflicts of interest or legal liability in our report. Guarantor Zhoupeng Wu. Data availability The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.